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INTERVIEW - Meena Seshu,
Director, SANGRAM |
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| "The risk of getting HIV is a gendered
risk which places the burden of the epidemic on the woman." |
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| Can you tell us about your journey working
on HIV/AIDS in India, and especially with women? |
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| The HIV/AIDS epidemic has singled out people-in-prostitution
and sex-work as `carriers and vectors of the spread of HIV'.
Apart from the stigma already attached to their work, society
has further marginalised them as core transmitters of the HIV
infection. |
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| It fails to understand and recognise that they are but links
in the broad networks of heterosexual transmission of HIV. And
that they constitute a community that bears and will continue
to bear the greatest impact of the HIV epidemic. Propagating
the myth that people-in-prostitution and sex work are core transmitters
of HIV serves the purpose of `prostitution bashers' imbued with
the moral and judgmental attitude that reinforces the prejudice
that AIDS is an 'impure' disease that afflicts immoral and evil
persons. The net result is to further target the women which: |
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- Increases public and police violence against them;
- Decreases their ability to assert themselves;
- Allows customers to demand and force unsafe sex upon them;
- Increases the rate of HIV among sex workers, customers and
the families of the
customers and;
- Denies them access to health care services.
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| The truth is that, women who are in prostitution and sex work
are very vulnerable. They are very often subjected to sexual
abuse at the hands of authorities, including local criminal
gangs, petty political leaders, immigration and police officials.
Given the fact that HIV transmission is most efficient in a
situation of repression and abuse, women in prostitution who
have been trafficked are at a greater risk of contracting HIV. |
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| Women in any community usually have the least access to information,
including information on taboo topics like HIV and sexuality.
At the same time, it is difficult to access women through schools,
colleges, and at public village meetings, since women constitute
a key constituency for the District Campaign, SANGRAM has evolved
a special strategy to reach women and provide them information
in a comfortable setting. The maitrin program recruits women
from villages who can take on a role of a maitrin or girl friend.
A friend is someone with whom one can openly discuss intimate
matters, and this is the role that each maitrin fulfills. Each
maitrin carries the message of HIV awareness to other women
in her village, gets women together to attend village programs
and maintains close contact with the mahila sanghatikas. While
the 20-25 maitrins are voluntary links in the information chain.
By the end of 1998, the District Campaign had organized maitrin
meetings in 25 village clusters - about 1000 women collectively
attended these meetings. Women who are thus informed are likely
to pass on their knowledge, informally and socially in their
villages. Some of the experiences narrated by the maitrins have
been touching, in that they depict the extreme vulnerability
of women living within marriages where they have no control
whatsoever on their lives much less on the means to protect
themselves from ill health. The effort is to build support groups
for women in each village such that they can at least address
their grievances to some extent. In the community of women in
prostitution it is seen that infected women get positive support
from the other women in the community. Collectively women contribute
their efforts to get medical, social and economical support
for the infected women. Many a times they do funeral of the
person who dies with AIDS Related Complications. We have yet
to see such responses in the general population. |
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| Women living with HIV carry a double burden.
Do you see the situation improving? |
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| One of the major lessons learnt by SANGRAM's intervention
is that the HIV epidemic is being fueled by society's inequalities.
While poverty, caste, class and sexual minority have a great
impact on the spread of HIV, gender places the burden of the
epidemic on women. The risk of getting HIV is a gendered risk,
one that strongly depends on the actions and behaviors of individual
men and women playing out gender roles that society has constructed
for them. If women face a disproportionately high risk due to
their social status, women also face a greater share of the
HIV burden. All women- single, married, pregnant, widowed or
in prostitution-face the whiplash of gender when it comes to
HIV. The discrimination and stigma they face is much more than
that faced by their men folk. The burden of care also falls
squarely on their shoulders. In fact, HIV/AIDS remains yet another
arena where traditional gender struggles continue to be played
out at all structural levels- in the family, in the community,
and in society at large. |
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| Did you face any resistance as you were
working on sensitive issues like sex work and HIV? |
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| Initially yes. But the problem was not with the community;
it was with us as outsiders. |
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| Working with women in prostitution and sex work for the past
twelve years in the HIV/AIDS prevention programme has helped
address our own double standards and bias while dealing with
issues related to sexuality and prostitution. |
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| As our involvement with the women we worked with deepened,
our beliefs, ideas and notions about prostitution and women
in prostitution underwent a sea change. Our perception of prostitution
as 'exploitation, victimization, oppression, loose, immoral,
illegal', was shaken to the core. |
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| Indeed, it was not merely our ideas and beliefs that had to
be questioned and reformulated but even the very use of language
to describe the women had to be transformed. 'Whore 'harlots
'veshya' have been used as abuses for the 'fallen woman' the
subject of much public discourse. We have toiled to reclaim
some of the terminology, and assert our identities with positive
meaning. |
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| We revised our vocabulary to weed out words, which reinforce
the stigmatization and marginalisation of women in prostitution.
Hence, the importance of the use of terminology like 'women
in prostitution' instead of the commonly used term 'prostitute'.
Women who practice prostitution use the term 'women in business'
while referring to themselves. Now after much discussion among
ourselves we have adopted the term People in Prostitution and
Sex work [PPS] to include all persons who 'make money out of
sex.' |
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| What do you think are the most important
issues confronting the people living with HIV/AIDS today? In
your opinion what all steps should be taken to empower HIV positive
women? |
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| Women in prostitution have not just been stigmatized by society
they have been criminalized. |
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| 1. With AIDS, the stigma has increased ten-fold. Manuals on
AIDS control refer to them as `vectors in the spread of AIDS'
or `the bridge population'. This thinking diverts us from coming
up with holistic strategies, involving all sections of society,
to combat AIDS and criminalizes these women further. |
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| 2. The most important lesson learnt by SANGRAM is that those
trusted by the community at risk do the most effective education
on HIV transmission. This means that sex workers have the best
chance of helping other sex workers protect themselves from
HIV and the collectives of women in prostitution are most successful
at combating problems within the sex industry, including HIV
and AIDS. There is an immediate need to recognize the lifesaving
work done by the collectives that are non-coercive and promote
respect for marginalized members of society. SANGRAM launched
a highway health outreach program through which smaller women
collectives educate women in prostitution to protect themselves,
and access and distribute millions of condoms a year to sex
workers. |
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| 3. "When we first came, so many women were going in for
abortions. Many had sexually transmitted diseases. The general
wisdom was that if you took a penicillin shot would help prevent
diseases. Today, the rate of abortions has dropped drastically.
SANGRAM through VAMP` Veshya Ananyay Mukti Parishad' helps women
in prostitution to protect themselves and others". |
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| The voicelessness of women and increasing violence against
those most affected by the epidemic. |
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| 4. Policy makers cling to the idea that the epidemic is limited
to "high-risk groups" as sex workers, drug users and
Men who have Sex with Men and that targeting these groups with
information about condoms and how AIDS is transmitted is the
best strategy to contain the epidemic. |
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| 5. Yet this no longer reflects the reality of AIDS, at least
for the Indian states like Maharashtra where it is in the general
population. In these states, women who have sex only with their
husbands may be the group at highest risk of HIV transmission. |
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| 6. The long-standing subordination of women and girls in Indian
society takes on lethal dimensions with the rapid spread of
HIV. Though men can experiment with sex outside of marriage
without any social stigma, women do not even have the status
to demand that husbands who may bring sexually transmitted diseases
home use condoms. |
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| 7. Many Indian women are experiencing what their African sisters
have known for years: that being left a widow by a man who dies
from AIDS is a ticket to abandonment by his family and dire
poverty and discrimination. And although they are a high-risk
group for HIV transmission and the worst consequences of AIDS,
most programs ignore married women. |
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| 8. Even in those Indian states where the epidemic may still
be contained among traditionally vulnerable groups, violence
undermines HIV and AIDS programs. Women in Prostitution and
sex work are continually subjected to violence by police officers,
who take their cue from society's condemnation of these women.
The violence of AIDS-related stigma also confronts AIDS educators,
homosexual men and other marginalized people. |
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| 9. The most effective education on HIV transmission is done
by those trusted by the community at risk. This means that sex
workers have the best chance of helping other sex workers protect
themselves from HIV. But peer education is not getting a fair
chance in India. The police apparently do not recognize the
lifesaving work done by AIDS educators, and these people face
consistent abuse. |
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| Access to treatment the biggest challenge. |
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| 10. Another major lesson learnt has been that HIV prevention
alone cannot succeed, ignoring the needs of millions already
living with HIV and AIDS. Positive people continue to face abuse
and discrimination in the health-care system, and unless they
are rich they can hardly hope for the basics of treatment of
even secondary infections, let alone medicines for HIV itself. |
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| 11. Access to health care and treatment services is fast becoming
a dream for people affected and infected with the HIV virus.
The stigma and discrimination is adding to their agony in a
real sense when they realize that the medical establishment
refuses to treat even simple opportunistic infections. |
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| 12. India is one of the biggest producers of the drugs that
have transformed the lives of people with AIDS in wealthy countries,
yet millions of Indians cannot get these medicines. |
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| What changes would you like to see in India's
AIDS prevention measures? |
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| A holistic approach is the need of the hour: |
- We need a collective review of strategies, policies,
laws, legal institutions and implementing
structures.
- Any framework of action must have a bottom up approach.
- Confidentiality must be maintained in order to create
services for sex workers and women in mainstream society
to access treatment especially for HIV related illness.
- Peer education and training programs have proved that
the impossible is possible.
- Sex workers do reach out to sympathetic social workers
with the right attitude.
- Special efforts to build coalitions and alliances must
be made to advocate for change: social, political and legal.
- It is imperative that interventions are influenced by
an approach that places human rights,
dignity and the status of vulnerable groups as the core
value.
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| Are perceptions on sex work changing? |
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| Not really. There is such a judgmental attitude towards sex
work that it will take the prostitutes rights activists a long
time before we can see change in the general public. |
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| About
Meenu Seshu |
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